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While widely used in research, the 1991 Rome criteria for the gastroduodenal disorders, especially symptom subgroups in dyspepsia, remain contentious. After a comprehensive literature search, a consensus-based approach was applied, supplemented by input from international experts who reviewed the report. Three functional gastroduodenal disorders are defined. Functional dyspepsia is persistent or recurrent pain or discomfort centered in the upper abdomen; evidence of organic disease likely to explain the symptoms is absent, including at upper endoscopy. Discomfort refers to a subjective, negative feeling that may be characterized by or associated with a number of non-painful symptoms including upper abdominal fullness, early satiety, bloating, or nausea. A dyspepsia subgroup classification is proposed for research purposes, based on the predominant (most bothersome) symptom: (a) ulcer-like dyspepsia when pain (from mild to severe) is the predominant symptom, and (b) dysmotility-like dyspepsia when discomfort (not pain) is the predominant symptom. This classification is supported by recent evidence suggesting that predominant symptoms, but not symptom clusters, identify subgroups with distinct underlying pathophysiological disturbances and responses to treatment. Aerophagia is an unusual complaint characterized by air swallowing that is objectively observed and troublesome repetitive belching. Functional vomiting refers to frequent episodes of recurrent vomiting that is not self-induced nor medication induced, and occurs in the absence of eating disorders, major psychiatric diseases, abnormalities in the gut or central nervous system, or metabolic diseases that can explain the symptom. The current classification requires careful validation but the criteria should be of value in future research. (Gut 1999;45(Suppl II):II37-II42)

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Our aim was to test the hypothesis that there is a relation between antral phasic pressure activity and the emptying of solids and liquids from the intact human stomach after a mixed meal. This hypothesis was evaluated in 14 healthy individuals in whom we performed simultaneous antral manometry and radioscintigraphy after ingestion of a meal labeled with [99mTc]sulfur colloid in cooked egg (solid component) and [111In]DTPA (liquid component). Analysis of the data included an in-depth evaluation of different models for expressing both gastric emptying rates and antral pressure activity. We found that gastric emptying was adequately represented by a two-phase model consisting of lag and emptying periods and by a power exponential model for the liquid phase. Distal antral motility was accurately represented by the slope of the cumulative antral motility index. During the lag period for solids, the antral motility was inversely related to the duration of the lag. During the solid-emptying period, there was a positive correlation between emptying of solids and antral motility. No significant relation was found between antral motility and overall emptying of the liquid phase of the meal. However, a relationship was found when antral motility was related to liquid emptying after an initial lag period for solids. These human data are consistent with a role of antral pressure activity in trituration of solid food and a role of the antrum in the subsequent propulsion of solids and liquids from the stomach.

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